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A labyrinthine fistula is a frequent complication of long-standing unsafe chronic suppurative otitis media. It is characterized by a slowly progressive erosion of the bony labyrinth. In this paper we present our observations regarding the diagnosis and management in 50 patients with unsafe chronic suppurative otitis media with labyrinthine fistula.

The facial nerve is unique among the motor nerves. It has long and tortuous course through the temporal bone and within the Fallopian canal. Because of this it is more prone to paralysis than any other nerve in the body. The most frequent type of facial palsy is Bell's palsy. This is an acute idiopathic lower motor neuron palsy of the facial nerve which does not normally progress and which is most usually unilateral and self limiting,: the majority of cases remit within 4-6 months and nearly always remission is complete by 1 year. In those cases that do not recover it is my contention that this is caused by Either the progression, or after effects, of secondary ischemia: tertiary ischemia. In turn this causes thickening of the facial nerve sheath with a fibrous band or bands forming with resultant strangulation and compression of the nerve, which hampers its recovery. In such cases facial nerve decompression with slitting of the sheath and cutting of any fibrous bands would be the preferred management when allied with aggressive medical therapy.

Pleomorphic adenomas of the minor salivary glands are rare. The most common site is in the palate. We have come across a case of pedunculated pleomorphic adenoma of the base of die tongue which came to us only when the tumour had caused respiratory distress. Case ReportK.D., a 35-year-old male patient, came to the Department of Otolaryngology and Head and Neck Surgery of B. Y. L. Nair Charitable Hospital with a complaint of dysphagia for three months. The dysphagia was gradually increasing and when he came to us he was on a semi-solid and liquid diet For one month the patient had been getting violent bouts of coughing along with attacks of suffocation. The patient used to feel comfortable in the lying position, but the attacks of suffocation had increased progressively and for two days he had been in respiratory distress.On examination of the oral cavity with the tongue depressor, the gag reflex resulted in the expulsion of a polypoidal, nodular, reddish mass approximately 4 cm. in diameter in the oral cavity, with bouts of coughing followed by attacks of suffocation (Fig. 1). On indirect laryngoscopy a nodular, reddish mass was seen to occupy the oropharynx, and the laryngeal inlet was not visible.The patient was in respiratory distress so we decided to remove the tumour by performing an emergency operation. The operation was done under general anaesthesia with nasotracheal intubatioa First, nasotracheal intubation was done and then general anaesthesia was administered. Doyen's mouth gag was applied and the tongue was pulled out by a tongue clip. The tumour was palpated. It was firm, nodular, pedunculated and approximately 4 cm. in diameter. The pedicle of the tumour was attached at the base of the tongue, one centimetre behind the sulcus terminalis, slightly to the right of the mid-line. The tumour was held with tissueholding forceps and the pedicle was clamped, cut and transfixed, using the chromic catgut The tumour was well capsulated and its cut section had a homogeneous appearance, with areas of haemorrhage (Fig. 2). The post-operative period was uneventful. HistopathologyMultiple sections showed a non-keratinized squamous epithelial lining, and a minor salivary gland. Just underneath the surface, tumour tissue was seen. The tumour cells were polyhydral in shape and were arranged in sheets. The cells had a moderate amount of eosinophilic cytoplasm with vesicular nuclei. The ducts were lined by cuboidal epithelium and some of the duct lumina contained mucin. A few areas of pseudocartilage were seen From the

It is well known that cholesteatoma is three-dimensional; hence, we feel that its surgical management requires a three-dimensional approach in order to achieve the best curative and functional results. Retraction pockets are undeniably caused by chronic and recurrent eustachian tube obstruction. However, we found that the presence of a large mastoid antrum was an important, additional aetiological factor in the formation of a retraction pocket and its progression to cholesteatoma formation, with bone destruction and subsequent complications. Canal wall down tympanomastoidectomy--the 'on-disease' approach--is an innovative, three-dimensional technique based on universally accepted surgical principles. We modified the technique to ensure complete exposure and thereby eradication of the disease, with a resultant small cavity. Working in a three-dimensional field, we began drilling at the posterior meatal wall, lowering it while simultaneously widening the cavity as the mastoid was drilled to reach the antrum and the aditus. The bridge was lowered and the incus removed to completely expose the entire disease. The facial ridge was debulked and the temporalis fascia graft placed so as to simplify the middle-ear cleft. We present a comprehensive report of this technique, based upon 600 patients studied retrospectively over a five-year period. After one-year follow up, 546 patients had a dry, healed cavity. Canal wall down tympanomastoidectomy performed by the on-disease approach ensures complete eradication of the disease, with excellent curative as well as functional results.